Hepatitis A: Difference between revisions

Hepatovirus A
	Electron micrograph of Hepatovirus A virions
Virus classification
(unranked):	Virus
Realm:	Riboviria
Kingdom:	Orthornavirae
Phylum:	Pisuviricota
Class:	Pisoniviricetes
Order:	Picornavirales
Family:	Picornaviridae
Genus:	Hepatovirus
Species:	Hepatovirus A
Synonyms
	Hepatitis A virus; Human hepatitis A virus; Simian hepatitis A virus;

Hepatitis A
Hepatitis A
Other names	Infectious hepatitis
	A case of jaundice caused by hepatitis A
Specialty	Infectious disease, gastroenterology
Symptoms	Nausea, vomiting, diarrhea, dark urine, jaundice, fever, abdominal pain
Complications	Acute liver failure
Usual onset	2–6 weeks after infection
Duration	8 weeks
Causes	Fecal–oral route, eating food or drinking water contaminated with Hepatovirus A infected feces, sexual transmission through oro–anal and digital–rectal sexual acts.
Diagnostic method	Blood tests
Prevention	Hepatitis A vaccine, hand washing, properly cooking food
Treatment	Supportive care, liver transplantation
Frequency	114 million symptomatic and nonsymptomatic (2015)
Deaths	11,200

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Hepatitis A is an infectious disease of the liver caused by Hepatovirus A (HAV);^[7] it is a type of viral hepatitis.^[8] Many cases have few or no symptoms, especially in the young.^[1] The time between infection and symptoms, in those who develop them, is two–six weeks.^[2] When symptoms occur, they typically last eight weeks and may include nausea, vomiting, diarrhea, jaundice, fever, and abdominal pain.^[1] Around 10–15% of people experience a recurrence of symptoms during the 6 months after the initial infection.^[1] Acute liver failure may rarely occur, with this being more common in the elderly.^[1]

It is usually spread by eating food or drinking water contaminated with infected feces.^[1] Undercooked or raw shellfish are relatively common sources.^[9] It may also be spread through close contact with an infectious person.^[1] While children often do not have symptoms when infected, they are still able to infect others.^[1] After a single infection, a person is immune for the rest of their life.^[10] Diagnosis requires blood testing, as the symptoms are similar to those of a number of other diseases.^[1] It is one of five known hepatitis viruses: A, B, C, D, and E.

The hepatitis A vaccine is effective for prevention.^[11]^[12]^[13] ^[1]^[4]^{[needs update]} Some countries recommend it routinely for children and those at higher risk who have not previously been vaccinated.^[1]^[14] It appears to be effective for life.^[1] Other preventive measures include hand washing and properly cooking food.^[1] No specific treatment is available, with rest and medications for nausea or diarrhea recommended on an as-needed basis.^[1] Infections usually resolve completely and without ongoing liver disease.^[1] Treatment of acute liver failure, if it occurs, is with liver transplantation.^[1]

Globally, around 1.4 million symptomatic cases occur each year^[1] and about 114 million infections (symptomatic and asymptomatic).^[5] It is more common in regions of the world with poor sanitation and not enough safe water.^[14] In the developing world, about 90% of children have been infected by age 10, thus are immune by adulthood.^[14] It often occurs in outbreaks in moderately developed countries where children are not exposed when young and vaccination is not widespread.^[14] Acute hepatitis A resulted in 11,200 deaths in 2015.^[6] World Hepatitis Day occurs each year on July 28 to bring awareness to viral hepatitis.^[14]

Signs and symptoms

Early symptoms of hepatitis A infection can be mistaken for influenza, but some people, especially children, exhibit no symptoms at all. Symptoms typically appear two–six weeks (the incubation period) after the initial infection.^[15] About 90% of children do not have symptoms. The time between infection and symptoms, in those who develop them, is two–six weeks, with an average of 28 days.^[2]

The risk for symptomatic infection is directly related to age, with more than 80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infections.^[16]

Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months:^[17]

Fatigue
Fever
Nausea
Appetite loss
Jaundice, a yellowing of the skin or the whites of the eyes owing to hyperbilirubinemia
Bile is removed from the bloodstream and excreted in the urine, giving it a dark amber color
Diarrhea
Light or clay-colored faeces (acholic faeces)
Abdominal discomfort^[18]

Extrahepatic manifestations

Joint pains, red cell aplasia, pancreatitis and generalized lymphadenopathy are the possible extrahepatic manifestations. Kidney failure and pericarditis are very uncommon.^[19] If they occur, they show an acute onset and disappear upon resolution of the disease.^{[citation needed]}

Virology

Taxonomy

Hepatovirus A is a species of virus in the order Picornavirales, family Picornaviridae, genus Hepatovirus. Humans and other vertebrates serve as natural hosts of this genus.^[22]^[23]

Nine members of Hepatovirus are recognized.^[24] These species infect bats, rodents, hedgehogs, and shrews. Phylogenetic analysis suggests a rodent origin for human Hepatitis A.^[25]

A member virus of hepatovirus B (Phopivirus) has been isolated from a seal.^[26]^[27] This virus shared a common ancestor with Hepatovirus A about 1800 years ago.^{[citation needed]}

Another hepatovirus – Marmota himalayana hepatovirus – has been isolated from the woodchuck Marmota himalayana.^[28] This virus appears to have had a common ancestor with the primate-infecting species around 1000 years ago.^{[citation needed]}

Genotypes

One serotype and six different genotypes (three human and three simian) have been described.^[29] The human genotypes are numbered I–III. Six subtypes have been described (IA, IB, IIA, IIB, IIIA, IIIB). The simian genotypes have been numbered IV–VI. A single isolate of genotype VII isolated from a human has also been described^[30] but has been reclassified as subgenotype IIB.^[31] Genotype III has been isolated from both humans and owl monkeys. Most human isolates are of genotype I.^[32] Of genotype I isolates, subtype IA accounts for the majority.

The mutation rate in the genome has been estimated to be 1.73–9.76 × 10⁻⁴ nucleotide substitutions per site per year.^[33]^[34] The human strains appear to have diverged from the simian about 3600 years ago.^[34] The mean age of genotypes III and IIIA strains has been estimated to be 592 and 202 years, respectively.^[34]

Structure

Hepatovirus A is a picornavirus; it is not enveloped and contains a positive-sense, single-strand of RNA packaged in a protein shell.^[29] Only one serotype of the virus has been found, but multiple genotypes exist.^[35] Codon use within the genome is biased and unusually distinct from its host. It also has a poor internal ribosome entry site.^[36] In the region that codes for the HAV capsid, highly conserved clusters of rare codons restrict antigenic variability.^[22]^[37]

Genus	Structure	Symmetry	Capsid	Genomic arrangement	Genomic segmentation
Hepatovirus	Icosahedral	Pseudo T=3	Nonenveloped	Linear	Monopartite

Replication cycle

Vertebrates such as humans serve as the natural hosts. Transmission routes are fecal-oral and blood.^[22]

Following ingestion, HAV enters the bloodstream through the epithelium of the oropharynx or intestine.^[38] The blood carries the virus to its target, the liver, where it multiplies within hepatocytes and Kupffer cells (liver macrophages). Viral replication is cytoplasmic. Entry into the host cell is achieved by attachment of the virus to host receptors, which mediates endocytosis. Replication follows the positive-stranded RNA virus replication model. Translation takes place by viral initiation. The virus exits the host cell by lysis and viroporins. Virions are secreted into the bile and released in stool. HAV is excreted in large numbers about 11 days prior to the appearance of symptoms or anti-HAV IgM antibodies in the blood. The incubation period is 15–50 days and risk of death in those infected is less than 0.5%.^{[citation needed]}

Within the liver hepatocytes, the RNA genome is released from the protein coat and is translated by the cell's own ribosomes. Unlike other picornaviruses, this virus requires an intact eukaryotic initiation factor 4G (eIF4G) for the initiation of translation.^[39] The requirement for this factor results in an inability to shut down host protein synthesis, unlike other picornaviruses. The virus must then inefficiently compete for the cellular translational machinery, which may explain its poor growth in cell culture. Aragonès et al. (2010) theorize that the virus has evolved a naturally highly deoptimized codon usage with respect to that of its cellular host in order to negatively influence viral protein translation kinetics and allow time for capsid proteins to fold optimally.^[39]

No apparent virus-mediated cytotoxicity occurs, presumably because of the virus' own requirement for an intact eIF4G, and liver pathology is likely immune-mediated.

Genus	Host details	Tissue tropism	Entry details	Release details	Replication site	Assembly site	Transmission
Hepatovirus	Humans; vertebrates	Liver	Cell receptor endocytosis	Lysis	Cytoplasm	Cytoplasm	Oral-fecal; blood

Transmission

The virus primarily spreads by the fecal–oral route,^[3] and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A can be transmitted by the parenteral route, but very rarely by blood and blood products. Food-borne outbreaks are common,^[40] and ingestion of shellfish cultivated in polluted water is associated with a high risk of infection.^[41] HAV can also be spread through sexual contact, specifically oro–anal and digital–rectal sexual acts.^[3] Humans are the only natural reservoir and disease vector of the HAV virus; no known insect or other animal vectors can transmit the virus. A chronic HAV state has not been reported.^[42]

About 40% of all acute viral hepatitis is caused by HAV.^[38] Infected individuals are infectious prior to onset of symptoms, roughly 10 days following infection. The virus is resistant to detergent, acid (pH 1), solvents (e.g., ether, chloroform), drying, and temperatures up to 60 °C. It can survive for months in fresh and salt water. Common-source (e.g., water, food) outbreaks are typical. Infection is common in children in developing countries, reaching 100% incidence, but following infection, lifelong immunity results. HAV can be inactivated by chlorine treatment (drinking water), formalin (0.35%, 37 °C, 72 hours), peracetic acid (2%, 4 hours), beta-propiolactone (0.25%, 1 hour), and UV radiation (2 μW/cm²/min).

In developing countries, and in regions with poor hygiene standards, the rates of infection with this virus are high^[43] and the illness is usually contracted in early childhood. As incomes rise and access to clean water increases, the incidence of HAV decreases.^[44] In developed countries, though, the infection is contracted primarily by susceptible young adults, most of whom are infected with the virus during trips to countries with a high incidence of the disease^[2] or through contact with infectious persons.

Diagnosis

Although HAV is excreted in the feces towards the end of the incubation period, specific diagnosis is made by the detection of HAV-specific IgM antibodies in the blood.^[45] IgM antibody is only present in the blood following an acute hepatitis A infection. It is detectable from 1–2 weeks after the initial infection and persists for up to 14 weeks. The presence of IgG antibodies in the blood means the acute stage of the illness has passed and the person is immune to further infection. IgG antibodies to HAV are also found in the blood following vaccination, and tests for immunity to the virus are based on the detection of these antibodies.^[45]

During the acute stage of the infection, the liver enzyme alanine transferase (ALT) is present in the blood at levels much higher than is normal. The enzyme comes from the liver cells damaged by the virus.^[46]

Hepatovirus A is present in the blood (viremia) and feces of infected people up to 2 weeks before clinical illness develops.^[46]

Prevention

Hepatitis A can be prevented by vaccination, good hygiene, and sanitation.^[7]^[47]

Vaccination

The two types of vaccines contain either inactivated Hepatovirus A or a live but attenuated virus.^[4] Both provide active immunity against a future infection. The vaccine protects against HAV in more than 95% of cases for longer than 25 years.^[48] In the United States, the vaccine developed by Maurice Hilleman and his team was licensed in 1995,^[49]^[50] and the vaccine was first used in 1996 for children in high-risk areas, and in 1999 it was spread to areas with elevating levels of infection.^[51]

The vaccine is given by injection. An initial dose provides protection lasting one year starting 2–4 weeks after vaccination; the second booster dose, given six to 12 months later, provides protection for over 20 years.^[51]

The vaccine was introduced in 1992 and was initially recommended for persons at high risk. Since then, Bahrain and Israel have embarked on elimination programmes.^[52] In countries where widespread vaccination has been practised, the incidence of hepatitis A has decreased dramatically.^[53]^[54]^[55]^[56]

In the United States, vaccination of children is recommended at 1 and 2 years of age;^[1] hepatitis A vaccination is not recommended in those younger than 12 months of age.^[57] It is also recommended in those who have not been previously immunized and who have been exposed or are likely to be exposed due to travel.^[1] The CDC recommends vaccination against infection for men who have sex with men.^[58]

Treatment

No specific treatment for hepatitis A is known. Recovery from symptoms following infection may take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhea.^[18]

Prognosis

In the United States in 1991, the mortality rate for hepatitis A was estimated to be 0.015% for the general population, but ranged up to 1.8–2.1% for those aged 50 and over who were hospitalized with icteric hepatitis.^[59] The risk of death from acute liver failure following HAV infection increases with age and when the person has underlying chronic liver disease.^{[citation needed]} Liver illness can be brought on by the hepatitis C virus, also known as Hep C or HCV. While the majority of kids and teenagers recover from the initial stage of HCV infection, 60–80% of them could show symptoms of a persistent liver infection. This may result in fatalities as well as far more severe liver issues. In the US, the hepatitis C virus is responsible for over 10,000 fatalities annually.

Young children who are infected with hepatitis A typically have a milder form of the disease, usually lasting 1–3 weeks, whereas adults tend to experience a much more severe form of the disease.^[40]

Epidemiology

Globally, symptomatic HAV infections are believed to occur in around 1.4 million people a year.^[1] About 114 million infections (asymptomatic and symptomatic) occurred all together in 2015.^[5] Acute hepatitis A resulted in 11,200 deaths in 2015.^[6] Developed countries have low circulating levels of hepatovirus A, while developing countries have higher levels of circulation.^[60] Most adolescents and adults in developing countries have already had the disease, thus are immune.^[60] Adults in midlevel countries may be at risk of disease with the potential of being exposed.^[60]

Countries

Over 30,000 cases of hepatitis A were reported to the CDC in the US in 1997, but the number has since dropped to less than 2,000 cases reported per year.^[61]

The most widespread hepatitis A outbreak in the United States occurred in 2018, in the state of Kentucky. The outbreak is believed to have started in November 2017.^[62] By July 2018 48% of the state's counties had reported at least one case of hepatitis A, and the total number of suspected cases was 969 with six deaths (482 cases in Louisville, Kentucky).^[63] By July 2019 the outbreak had reached 5,000 cases and 60 deaths, but had slowed to just a few new cases per month.^[62]

Another widespread outbreak in the United States, the 2003 US hepatitis outbreak, affected at least 640 people (killing four) in northeastern Ohio and southwestern Pennsylvania in late 2003. The outbreak was blamed on tainted green onions at a restaurant in Monaca, Pennsylvania.^[64]^[65] In 1988, more than 300,000 people in Shanghai, China, were infected with HAV after eating clams (Anadara subcrenata) from a contaminated river.^[38] In June 2013, frozen berries sold by US retailer Costco and purchased by around 240,000 people were the subject of a recall, after at least 158 people were infected with HAV, 69 of whom were hospitalized.^[66]^[67] In April 2016, frozen berries sold by Costco were once again the subject of a recall, after at least 13 people in Canada were infected with HAV, three of whom were hospitalized.^[68] In Australia in February 2015, a recall of frozen berries was issued after at least 19 people contracted the illness following their consumption of the product.^[69] In 2017, California (particularly around San Diego), Michigan, and Utah reported outbreaks of hepatitis A that have led to over 800 hospitalizations and 40 deaths.^[70]^[71]^[72]

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^ Arankalle VA, Chadha MS, Chitambar SD, Walimbe AM, Chobe LP, Gandhe SS (21 December 2001). "Changing epidemiology of hepatitis A and hepatitis E in urban and rural India (1982-98)". Journal of Viral Hepatitis. 8 (4): 293–303. doi:10.1046/j.1365-2893.2001.00279.x. PMID 11454182. S2CID 8761651.
^ Estripeaut D, Contreras R, Tinajeros O, Castrejón MM, Shafi F, Ortega-Barria E, Deantonio R (22 June 2015). "Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis". Vaccine. 33 (28). Elseiver: 3200–3207. doi:10.1016/j.vaccine.2015.04.100. PMID 25981490.
^ Cui F, Hadler SC, Zheng H, Wang F, Zhenhua W, Yuansheng H, Gong X, Chen Y, Liang X, et al. (2009). "Hepatitis A surveillance and vaccine use in China from 1990 through 2007". J Epidemiol. 19 (4): 189–195. doi:10.2188/jea.JE20080087. PMC 3924108. PMID 19561383.
^ Daniels D, Grytdal S, Wasley A (May 2009). "Surveillance for acute viral hepatitis — United States, 2007" (PDF). MMWR Surveill Summ. 58 (3): 1–27. PMID 19478727. Archived (PDF) from the original on 2012-05-19.
^ "Hepatitis A Questions and Answers for Health Professionals | Division of Viral Hepatitis | CDC". www.cdc.gov. 2018-07-27. Archived from the original on 2016-03-06. Retrieved 2018-08-15.
^ "Men Who Have Sex with Men | Populations and Settings | Division of Viral Hepatitis | CDC". www.cdc.gov. 31 May 2015. Archived from the original on 2008-07-26. Retrieved 2017-12-13.
^ "AABB" (PDF). Archived from the original (PDF) on 2020-10-30. Retrieved 2017-09-22.
^ ^a ^b ^c Jacobsen KH, Wiersma, ST (24 September 2010). "Hepatitis A virus seroprevalence by age and world region, 1990 and 2005". Vaccine. 28 (41): 6653–7. doi:10.1016/j.vaccine.2010.08.037. PMID 20723630.
^ "Hepatitis A Information for Health Professionals — Statistics and Surveillance". Centers for Disease Control and Prevention. Archived from the original on 3 February 2014. Retrieved 28 January 2014.
^ ^a ^b Wymer G (December 11, 2019). "Hepatitis A numbers down in Kentucky; health officials still urge vaccination". WKYT. Archived from the original on October 27, 2020. Retrieved September 1, 2020.
^ "Officials: Kentucky's hepatitis A outbreak now worst in US". WKYT. Associated Press. June 28, 2018. Archived from the original on August 9, 2020. Retrieved June 30, 2018.
^ Centers for Disease Control and Prevention (CDC) (November 2003). "Hepatitis A outbreak associated with green onions at a restaurant—Monaca, Pennsylvania, 2003" (PDF). MMWR Morb. Mortal. Wkly. Rep. 52 (47): 1155–7. PMID 14647018. Archived (PDF) from the original on 2011-10-18.
^ Wheeler C, Vogt TM, Armstrong GL, et al. (September 2005). "An outbreak of hepatitis A associated with green onions". N. Engl. J. Med. 353 (9): 890–7. doi:10.1056/NEJMoa050855. PMID 16135833.
^ Weise E (18 June 2013). "118 sickened in hepatitis A outbreak linked to berries". USA Today. Archived from the original on 2 January 2017.
^ "Outbreak Cases". Viral Hepatitis. Centers for Disease Control and Prevention. 28 October 2013. Archived from the original on 12 August 2013.
^ "Recalled Costco frozen berries linked to 13 cases of Hepatitis A". The Canadian Press. 19 April 2016. Archived from the original on 17 March 2017.
^ "Frozen berries Heptitus A scare". ABC News Australia. 17 February 2015. Archived from the original on 19 February 2015.
^ Ramseth, Luke (November 19, 2017). "Utah's hepatitis A outbreak among the homeless is one of three big flare-ups around the country". The Salt Lake Tribune. Archived from the original on November 21, 2017. Retrieved November 21, 2017.
^ "San Diego is struggling with a huge hepatitis A | Word Range". wordrange.us. Archived from the original on 2017-09-25. Retrieved 2017-09-25.
^ Smith JE. "Grim conditions in public restrooms hurt fight to halt deadly hepatitis outbreak in San Diego". LA Times. Archived from the original on 25 September 2017. Retrieved 25 September 2017.

External links

Template:Curlie
CDC's hepatitis A links Archived 2008-06-05 at the Wayback Machine
Virus Pathogen Database and Analysis Resource (ViPR): Picornaviridae Archived 2022-10-31 at the Wayback Machine
Human hepatitis A virus Archived 2021-04-28 at the Wayback Machine

[AFP2012-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z Matheny SC, Kingery JE (1 December 2012). "Hepatitis A." Am Fam Physician. 86 (11): 1027–34, quiz 1010–1012. PMID 23198670. Archived from the original on 9 March 2014.

[pmid16271543-2] Connor BA (2005). "Hepatitis A vaccine in the last-minute traveler". Am. J. Med. 118 (Suppl 10A): 58S–62S. doi:10.1016/j.amjmed.2005.07.018. PMID 16271543.

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@@ Line 13: / Line 13: @@
 | duration        = 8 weeks<ref name=AFP2012/>
 | types           =
-| causes          = Eating food or drinking water contaminated with ''Hepatovirus A'' infected [[feces]]<ref name=AFP2012/>
+| causes          = [[Fecal–oral route]],<ref name="pmid17151052"/> eating food or drinking water contaminated with ''Hepatovirus A'' infected [[feces]],<ref name=AFP2012/> [[Sexually transmitted infection|sexual transmission]] through [[Anilingus|oro–anal]] and [[Anal fingering|digital–rectal]] sexual acts.<ref name="pmid17151052"/>
 | risks           =
 | diagnosis       = Blood tests<ref name=AFP2012/>
@@ Line 25: / Line 25: @@
 }}
-'''Hepatitis A''' is an infectious disease of the [[liver]] caused by ''Hepatovirus A'' (HAV);<ref name=Sherris>{{cite book |veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | pages = 541–4 | publisher = McGraw Hill | year = 2004 | isbn = 978-0-8385-8529-0 }}</ref> it is a type of [[viral hepatitis]].<ref>{{Cite web |title=Hepatitis MedlinePlus |url=https://medlineplus.gov/hepatitis.html |access-date=2020-06-19 |website=U.S. National Library of Medicine}}</ref> Many cases have few or no symptoms, especially in the young.<ref name=AFP2012/> The time between infection and symptoms, in those who develop them, is 2–6 weeks.<ref name="pmid16271543">{{cite journal| author=Connor BA| title=Hepatitis A vaccine in the last-minute traveler| journal=Am. J. Med.| volume=118 |issue=Suppl 10A| pages=58S–62S| year=2005| pmid=16271543| doi=10.1016/j.amjmed.2005.07.018}}</ref> When symptoms occur, they typically last 8 weeks and may include nausea, vomiting, diarrhea, [[jaundice]], fever, and abdominal pain.<ref name=AFP2012/> Around 10–15% of people experience a recurrence of symptoms during the 6 months after the initial infection.<ref name=AFP2012/> [[Acute liver failure]] may rarely occur, with this being more common in the elderly.<ref name=AFP2012/>
+'''Hepatitis A''' is an infectious disease of the [[liver]] caused by ''Hepatovirus A'' (HAV);<ref name=Sherris>{{cite book |veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | pages = 541–4 | publisher = McGraw Hill | year = 2004 | isbn = 978-0-8385-8529-0 }}</ref> it is a type of [[viral hepatitis]].<ref>{{Cite web |title=Hepatitis MedlinePlus |url=https://medlineplus.gov/hepatitis.html |access-date=2020-06-19 |website=U.S. National Library of Medicine |archive-date=2016-11-11 |archive-url=https://web.archive.org/web/20161111061624/https://medlineplus.gov/hepatitis.html |url-status=live }}</ref> Many cases have few or no symptoms, especially in the young.<ref name=AFP2012/> The time between infection and symptoms, in those who develop them, is two–six weeks.<ref name="pmid16271543">{{cite journal| author=Connor BA| title=Hepatitis A vaccine in the last-minute traveler| journal=Am. J. Med.| volume=118 |issue=Suppl 10A| pages=58S–62S| year=2005| pmid=16271543| doi=10.1016/j.amjmed.2005.07.018}}</ref> When symptoms occur, they typically last eight weeks and may include nausea, vomiting, diarrhea, [[jaundice]], fever, and abdominal pain.<ref name=AFP2012/> Around 10–15% of people experience a recurrence of symptoms during the 6 months after the initial infection.<ref name=AFP2012/> [[Acute liver failure]] may rarely occur, with this being more common in the elderly.<ref name=AFP2012/>
 It is usually spread by eating food or drinking water contaminated with infected feces.<ref name=AFP2012>{{cite journal |last1=Matheny |first1=SC|last2=Kingery|first2=JE|title=Hepatitis A.|journal=Am Fam Physician|date=1 December 2012|volume=86|issue=11|pages=1027–34; quiz 1010–1012 |pmid=23198670 |url=http://www.aafp.org/afp/2012/1201/p1027.html|url-status=live|archive-url=https://web.archive.org/web/20140309112808/http://www.aafp.org/afp/2012/1201/p1027.html|archive-date=9 March 2014}}</ref> Undercooked or raw [[shellfish]] are relatively common sources.<ref>{{Cite journal  | last1 = Bellou | first1 = M. | last2 = Kokkinos | first2 = P. | last3 = Vantarakis | first3 = A. | title = Shellfish-borne viral outbreaks: a systematic review. | journal = Food Environ Virol | volume = 5 | issue = 1 | pages = 13–23 |date=March 2013 | doi = 10.1007/s12560-012-9097-6 | pmid = 23412719 | s2cid = 16273385 }}</ref> It may also be spread through close contact with an infectious person.<ref name=AFP2012/> While children often do not have symptoms when infected, they are still able to infect others.<ref name=AFP2012/> After a single infection, a person is [[Immunity (medical)|immune]] for the rest of their life.<ref>{{cite book|title=The Encyclopedia of Hepatitis and Other Liver Diseases |year=2006 |publisher=Infobase|isbn=978-0-8160-6990-3 |page=105 |url=https://books.google.com/books?id=HfPU99jIfboC&pg=PA105 |url-status=live|archive-url=https://web.archive.org/web/20170908220821/https://books.google.com/books?id=HfPU99jIfboC&pg=PA105 |archive-date=2017-09-08}}</ref> Diagnosis requires blood testing, as the symptoms are similar to those of a number of other diseases.<ref name=AFP2012/> It is one of five known [[hepatitis]] viruses: A, [[hepatitis B|B]], [[hepatitis C|C]], [[hepatitis D|D]], and [[hepatitis E|E]].
+The [[hepatitis A vaccine]] is effective for prevention.<ref>{{cite web|title= Hepatitis A outbreaks bring back focus on vaccination in Kerala|publisher= thehindu|date= 2024|url= https://www.thehindu.com/news/national/kerala/hepatitis-a-outbreaks-bring-back-focus-on-vaccination-in-kerala/article67913165.ece|access-date= 2024-03-20|archive-date= 2024-03-20|archive-url= https://web.archive.org/web/20240320043807/https://www.thehindu.com/news/national/kerala/hepatitis-a-outbreaks-bring-back-focus-on-vaccination-in-kerala/article67913165.ece|url-status= live}}</ref><ref>{{cite web|title= Viral hepatitis could cause liver cancer: Here's what you need to know about prevention and treatment|publisher= theeconomictimes|date= 2023|url= https://economictimes.indiatimes.com/news/international/uae/viral-hepatitis-could-cause-liver-cancer-heres-what-you-need-to-know-about-prevention-and-treatment/articleshow/102537628.cms|access-date= 2024-03-20|archive-date= 2024-03-20|archive-url= https://web.archive.org/web/20240320043807/https://economictimes.indiatimes.com/news/international/uae/viral-hepatitis-could-cause-liver-cancer-heres-what-you-need-to-know-about-prevention-and-treatment/articleshow/102537628.cms|url-status= live}}</ref><ref>{{cite web|title= Indian Immunologicals unveils indigenously developed Hepatitis A vaccine|publisher= theeconomictimes|date= 2024|url= https://www.thehindu.com/news/cities/Hyderabad/indian-immunologicals-unveils-indigenously-developed-hepatitis-a-vaccine/article67756040.ece|access-date= 2024-03-20|archive-date= 2024-03-20|archive-url= https://web.archive.org/web/20240320043807/https://www.thehindu.com/news/cities/Hyderabad/indian-immunologicals-unveils-indigenously-developed-hepatitis-a-vaccine/article67756040.ece|url-status= live}}</ref>
-The [[hepatitis A vaccine]] is effective for prevention.<ref name=AFP2012/><ref name=Irv2012>{{Cite journal  |vauthors = Irving GJ, Holden J, Yang R, Pope D | title = Hepatitis A immunisation in persons not previously exposed to hepatitis A. | journal = Cochrane Database Syst Rev | volume = 7 | issue =  7| pages = CD009051 | year = 2012 | doi = 10.1002/14651858.CD009051.pub2 | pmid = 22786522 | pmc = 6823267 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/31846062|date = February 2020}} Some countries recommend it routinely for children and those at higher risk who have not previously been vaccinated.<ref name=AFP2012/><ref name=WHO2013/> It appears to be effective for life.<ref name=AFP2012/> Other preventive measures include [[hand washing]] and properly cooking food.<ref name=AFP2012/> No specific treatment is available, with rest and medications for [[nausea]] or [[diarrhea]] recommended on an as-needed basis.<ref name=AFP2012/> Infections usually resolve completely and without ongoing liver disease.<ref name=AFP2012/> Treatment of acute liver failure, if it occurs, is with [[liver transplantation]].<ref name=AFP2012/>
+<ref name=AFP2012/><ref name=Irv2012>{{Cite journal  |vauthors = Irving GJ, Holden J, Yang R, Pope D | title = Hepatitis A immunisation in persons not previously exposed to hepatitis A. | journal = Cochrane Database Syst Rev | volume = 7 | issue =  7| pages = CD009051 | year = 2012 | doi = 10.1002/14651858.CD009051.pub2 | pmid = 22786522 | pmc = 6823267 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/31846062|date = February 2020}} Some countries recommend it routinely for children and those at higher risk who have not previously been vaccinated.<ref name=AFP2012/><ref name=WHO2013/> It appears to be effective for life.<ref name=AFP2012/> Other preventive measures include [[hand washing]] and properly cooking food.<ref name=AFP2012/> No specific treatment is available, with rest and medications for [[nausea]] or [[diarrhea]] recommended on an as-needed basis.<ref name=AFP2012/> Infections usually resolve completely and without ongoing liver disease.<ref name=AFP2012/> Treatment of acute liver failure, if it occurs, is with [[liver transplantation]].<ref name=AFP2012/>
 Globally, around 1.4 million symptomatic cases occur each year<ref name=AFP2012/> and about 114 million infections (symptomatic and asymptomatic).<ref name=GBD2015Pre>{{cite journal|author=((GBD 2015 Disease and Injury Incidence and Prevalence Collaborators)) |title=Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet|date=8 October 2016|volume=388|issue=10053|pages=1545–1602 |pmid=27733282 |doi=10.1016/S0140-6736(16)31678-6|pmc=5055577}}</ref> It is more common in regions of the world with poor sanitation and not enough safe water.<ref name=WHO2013>{{cite web|title=Hepatitis A Fact sheet N°328|url=https://www.who.int/mediacentre/factsheets/fs328/en/ |publisher=World Health Organization |access-date=20 February 2014 |date=July 2013 |url-status=live|archive-url=https://web.archive.org/web/20140221042107/http://www.who.int/mediacentre/factsheets/fs328/en/|archive-date=21 February 2014}}</ref> In the [[developing world]], about 90% of children have been infected by age 10, thus are immune by adulthood.<ref name=WHO2013/> It often occurs in outbreaks in moderately developed countries where children are not exposed when young and vaccination is not widespread.<ref name=WHO2013/> Acute [[hepatitis]] A resulted in 11,200 deaths in 2015.<ref name=GBD2015De>{{cite journal|author=((GBD 2015 Mortality and Causes of Death Collaborators)) |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet|date=8 October 2016 |volume=388 |issue=10053 |pages=1459–1544 |pmid=27733281 |doi=10.1016/s0140-6736(16)31012-1|pmc=5388903}}</ref> [[World Hepatitis Day]] occurs each year on July 28 to bring awareness to [[viral hepatitis]].<ref name=WHO2013/>
 ==Signs and symptoms==
-Early symptoms of ''hepatitis A'' infection can be mistaken for [[influenza]], but some people, especially children,  exhibit no symptoms at all.  Symptoms typically appear 2–6 weeks (the [[incubation period]]) after the initial infection.<ref>{{cite web | title = Hepatitis A Symptoms | publisher = eMedicineHealth | url = http://www.emedicinehealth.com/hepatitis_a/page3_em.htm#Hepatitis%20A%20Symptoms | date = 2007-05-17 | access-date = 2007-05-18 | url-status = live | archive-url = https://web.archive.org/web/20070602122159/http://www.emedicinehealth.com/hepatitis_a/page3_em.htm#Hepatitis%20A%20Symptoms | archive-date = 2007-06-02 }}</ref> About 90% of children do not have symptoms. The time between infection and symptoms, in those who develop them, is 2–6 weeks, with an average of 28 days.<ref name="pmid16271543"/>
+Early symptoms of ''hepatitis A'' infection can be mistaken for [[influenza]], but some people, especially children,  exhibit no symptoms at all.  Symptoms typically appear two–six weeks (the [[incubation period]]) after the initial infection.<ref>{{cite web | title = Hepatitis A Symptoms | publisher = eMedicineHealth | url = http://www.emedicinehealth.com/hepatitis_a/page3_em.htm#Hepatitis%20A%20Symptoms | date = 2007-05-17 | access-date = 2007-05-18 | url-status = live | archive-url = https://web.archive.org/web/20070602122159/http://www.emedicinehealth.com/hepatitis_a/page3_em.htm#Hepatitis%20A%20Symptoms | archive-date = 2007-06-02 }}</ref> About 90% of children do not have symptoms. The time between infection and symptoms, in those who develop them, is two–six weeks, with an average of 28 days.<ref name="pmid16271543"/>
 The risk for symptomatic infection is directly related to age, with more than 80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infections.<ref name="pmid10683554">{{cite journal |doi=10.1016/S0264-410X(99)00470-3 |author=Ciocca M. |title=Clinical course and consequences of hepatitis A infection |journal=Vaccine |volume=18 |pages=71–4|year=2000 |pmid=10683554}}</ref>
@@ Line 60: / Line 61: @@
 | species = Hepatovirus A
 | synonyms =
-* ''Hepatitis A virus''<ref name="2014.016aV">{{cite web |last1=Knowles |first1=Nick |title=Rename12 ''Picornavirus'' species |url=https://ictv.global/ictv/proposals/2014.016aV.A.v1.Picornaviridae_spren.pdf |website=International Committee on Taxonomy of Viruses (ICTV) |access-date=12 March 2019 |language=en |date=7 July 2014}}</ref>
+* ''Hepatitis A virus''<ref name="2014.016aV">{{cite web |last1=Knowles |first1=Nick |title=Rename12 ''Picornavirus'' species |url=https://ictv.global/ictv/proposals/2014.016aV.A.v1.Picornaviridae_spren.pdf |website=International Committee on Taxonomy of Viruses (ICTV) |access-date=12 March 2019 |language=en |date=7 July 2014 |archive-date=18 October 2022 |archive-url=https://web.archive.org/web/20221018010347/https://ictv.global/ictv/proposals/2014.016aV.A.v1.Picornaviridae_spren.pdf |url-status=live }}</ref>
-* ''Human hepatitis A virus''<ref name=ICTV7>van Regenmortel, M.H.V., Fauquet, C.M., Bishop, D.H.L., Carstens, E.B., Estes, M.K., Lemon, S.M., Maniloff, J., Mayo, M.A., McGeoch, D.J., Pringle, C.R. and Wickner, R.B. (2000). Virus taxonomy. Seventh report of the International Committee on Taxonomy of Viruses. Academic Press, San Diego. p672 https://ictv.global/ictv/proposals/ICTV%207th%20Report.pdf.</ref>
+* ''Human hepatitis A virus''<ref name=ICTV7>van Regenmortel, M.H.V., Fauquet, C.M., Bishop, D.H.L., Carstens, E.B., Estes, M.K., Lemon, S.M., Maniloff, J., Mayo, M.A., McGeoch, D.J., Pringle, C.R. and Wickner, R.B. (2000). Virus taxonomy. Seventh report of the International Committee on Taxonomy of Viruses. Academic Press, San Diego. p672 https://ictv.global/ictv/proposals/ICTV%207th%20Report.pdf {{Webarchive|url=https://web.archive.org/web/20230216033623/https://ictv.global/ictv/proposals/ICTV%207th%20Report.pdf |date=2023-02-16 }}.</ref>
 * ''Simian hepatitis A virus''<ref name=ICTV7/>
 | synonyms_ref =
@@ Line 69: / Line 70: @@
 ===Taxonomy===
-''Hepatovirus A'' is a species of [[virus]] in the order ''[[Picornavirales]]'', family ''[[Picornaviridae]]'', genus ''[[Hepatovirus]]''. Humans and other vertebrates serve as natural hosts.<ref name=ViralZone>{{cite web|title=Viral Zone|url=http://viralzone.expasy.org/all_by_species/94.html|publisher=ExPASy|access-date=15 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150617215332/http://viralzone.expasy.org/all_by_species/94.html|archive-date=17 June 2015}}</ref><ref name=ICTV>{{cite web|last1=ICTV|title=Virus Taxonomy: 2014 Release|url=http://ictvonline.org/virusTaxonomy.asp|access-date=15 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150710030353/http://ictvonline.org/virusTaxonomy.asp|archive-date=10 July 2015}}</ref>
+''Hepatovirus A'' is a species of [[virus]] in the order ''[[Picornavirales]]'', family ''[[Picornaviridae]]'', genus ''[[Hepatovirus]]''. Humans and other vertebrates serve as natural hosts of this genus.<ref name=ViralZone>{{cite web|title=Viral Zone |url=http://viralzone.expasy.org/all_by_species/94.html |publisher=ExPASy|access-date=15 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150617215332/http://viralzone.expasy.org/all_by_species/94.html|archive-date=17 June 2015}}</ref><ref name=ICTV>{{cite web|last1=ICTV|title=Virus Taxonomy: 2014 Release|url=http://ictvonline.org/virusTaxonomy.asp|access-date=15 June 2015|url-status=live |archive-url=https://web.archive.org/web/20150710030353/http://ictvonline.org/virusTaxonomy.asp|archive-date=10 July 2015}}</ref>
-Nine members of ''Hepatovirus'' are recognized.<ref name=ictv >{{cite web|url=https://ictv.global/taxonomy|title=Virus Taxonomy: 2019 Release|website=talk.ictvonline.org|publisher=International Committee on Taxonomy of Viruses|access-date=11 May 2020}}</ref> These species infect [[bat]]s, [[rodent]]s, [[hedgehog]]s, and [[shrew]]s. Phylogenetic analysis suggests a rodent origin for Hepatitis A.{{cn|date=January 2023}}
+Nine members of ''Hepatovirus'' are recognized.<ref name=ictv >{{cite web|url=https://ictv.global/taxonomy|title=Virus Taxonomy: 2019 Release|website=talk.ictvonline.org|publisher=International Committee on Taxonomy of Viruses|access-date=11 May 2020|archive-date=4 March 2018|archive-url=https://web.archive.org/web/20180304035352/https://talk.ictvonline.org/taxonomy/|url-status=live}}</ref> These species infect [[bat]]s, [[rodent]]s, [[hedgehog]]s, and [[shrew]]s. Phylogenetic analysis suggests a rodent origin for human Hepatitis A.<ref>{{Cite journal |last1=Drexler |first1=Jan Felix |last2=Corman |first2=Victor M. |last3=Lukashev |first3=Alexander N. |last4=van den Brand |first4=Judith M. A. |last5=Gmyl |first5=Anatoly P. |last6=Brünink |first6=Sebastian |last7=Rasche |first7=Andrea |last8=Seggewiß |first8=Nicole |last9=Feng |first9=Hui |last10=Leijten |first10=Lonneke M. |last11=Vallo |first11=Peter |last12=Kuiken |first12=Thijs |last13=Dotzauer |first13=Andreas |last14=Ulrich |first14=Rainer G. |last15=Lemon |first15=Stanley M. |date=2015-12-08 |title=Evolutionary origins of hepatitis A virus in small mammals |journal=Proceedings of the National Academy of Sciences |language=en |volume=112 |issue=49 |pages=15190–15195 |doi=10.1073/pnas.1516992112 |doi-access=free |issn=0027-8424 |pmc=4679062 |pmid=26575627 |bibcode=2015PNAS..11215190D}}</ref>
-A [[member virus]] of ''[[hepatovirus B]]'' (''[[Phopivirus]]'') has been isolated from a seal.<ref name=Anthony2015>{{cite journal |vauthors=Anthony SJ, St Leger JA, Liang E, Hicks AL, Sanchez-Leon MD, Jain K, Lefkowitch JH, Navarrete-Macias I, Knowles N, Goldstein T, Pugliares K, Ip HS, Rowles T, Lipkin WI | year = 2015 | title = Discovery of a novel hepatovirus (Phopivirus of seals) related to human hepatitis A virus | journal = mBio | volume = 6 | issue = 4| pages = e01180–15 | doi = 10.1128/mBio.01180-15 | pmid = 26307166 | pmc = 4550696 }}</ref><ref name="ICTV10">{{cite web |title=Genus: ''Hepatovirus'' |url=https://talk.ictvonline.org/ictv-reports/ictv_online_report/positive-sense-rna-viruses/picornavirales/w/picornaviridae/709/genus-hepatovirus |archive-url=https://web.archive.org/web/20200801133432/https://talk.ictvonline.org/ictv-reports/ictv_online_report/positive-sense-rna-viruses/picornavirales/w/picornaviridae/709/genus-hepatovirus |archive-date=August 1, 2020 |website=International Committee on Taxonomy of Viruses (ICTV) |access-date=12 March 2019 |language=en }}</ref> This virus shared a common ancestor with ''Hepatovirus A'' about 1800 years ago.{{citation needed|date=June 2021}}
+A [[member virus]] of ''[[hepatovirus B]]'' (''[[Phopivirus]]'') has been isolated from a seal.<ref name=Anthony2015>{{cite journal |vauthors=Anthony SJ, St Leger JA, Liang E, Hicks AL, Sanchez-Leon MD, Jain K, Lefkowitch JH, Navarrete-Macias I, Knowles N, Goldstein T, Pugliares K, Ip HS, Rowles T, Lipkin WI |year=2015 |title=Discovery of a novel hepatovirus (Phopivirus of seals) related to human hepatitis A virus | journal=mBio |volume=6 |issue=4| pages=e01180–15 |doi=10.1128/mBio.01180-15 |pmid=26307166 |pmc=4550696}}</ref><ref name="ICTV10">{{cite web |title=Genus: ''Hepatovirus'' |url=https://talk.ictvonline.org/ictv-reports/ictv_online_report/positive-sense-rna-viruses/picornavirales/w/picornaviridae/709/genus-hepatovirus |archive-url=https://web.archive.org/web/20200801133432/https://talk.ictvonline.org/ictv-reports/ictv_online_report/positive-sense-rna-viruses/picornavirales/w/picornaviridae/709/genus-hepatovirus |archive-date=August 1, 2020 |website=International Committee on Taxonomy of Viruses (ICTV) |access-date=12 March 2019 |language=en}}</ref> This virus shared a common ancestor with ''Hepatovirus A'' about 1800 years ago.{{citation needed|date=June 2021}}
 Another hepatovirus – [[Marmota himalayana hepatovirus]] – has been isolated from the woodchuck ''[[Marmota himalayana]]''.<ref name=Yu2016>{{cite journal |vauthors=Yu JM, Li LL, Zhang CY, Lu S, Ao YY, Gao HC, Xie ZP, Xie GC, Sun XM, Pang LL, Xu JG, Lipkin WI, Duan ZJ | year = 2016 | title = A novel hepatovirus identified in wild woodchuck ''Marmota himalayana'' | journal = Sci Rep | volume = 6 | page = 22361 | doi = 10.1038/srep22361 | pmid = 26924426 | pmc = 4770319 | bibcode = 2016NatSR...622361Y }}</ref> This virus appears to have had a common ancestor with the primate-infecting species around 1000 years ago.{{citation needed|date=June 2021}}
 ===Genotypes===
-One serotype and seven different genetic groups (four human and three simian) have been described.<ref name="pmid17328982"/> The human genotypes are numbered I–III. Six subtypes have been described (IA, IB, IIA, IIB, IIIA, IIIB). The simian genotypes have been numbered IV–VI. A single isolate of genotype VII isolated from a human has also been described.<ref name=Ching2002>{{cite journal |vauthors=Ching KZ, Nakano T, Chapman LE, Demby A, Robertson BH |title=Genetic characterization of wild-type genotype VII hepatitis A virus |journal=J. Gen. Virol. |volume=83 |issue=Pt 1 |pages=53–60 |date=January 2002 |pmid=11752700 |doi=10.1099/0022-1317-83-1-53 |doi-access=free }}</ref> Genotype III has been isolated from both humans and [[owl monkey]]s. Most human isolates are of genotype I.<ref name=dePaula2002>{{cite journal |vauthors=de Paula VS, Baptista ML, Lampe E, Niel C, Gaspar AM |title=Characterization of hepatitis A virus isolates from subgenotypes IA and IB in Rio de Janeiro, Brazil |journal=J. Med. Virol. |volume=66 |issue=1|pages=22–7 |date=January 2002 |pmid=11748654 |doi=10.1002/jmv.2106|s2cid=42775132 }}</ref> Of the type I isolates subtype IA accounts for the majority.
+One serotype and six different genotypes (three human and three simian) have been described.<ref name="pmid17328982"/> The human genotypes are numbered I–III. Six subtypes have been described (IA, IB, IIA, IIB, IIIA, IIIB). The simian genotypes have been numbered IV–VI. A single isolate of genotype VII isolated from a human has also been described<ref name=Ching2002>{{cite journal |vauthors=Ching KZ, Nakano T, Chapman LE, Demby A, Robertson BH |title=Genetic characterization of wild-type genotype VII hepatitis A virus |journal=J. Gen. Virol. |volume=83 |issue=Pt 1 |pages=53–60 |date=January 2002 |pmid=11752700 |doi=10.1099/0022-1317-83-1-53 |doi-access=free }}</ref> but has been reclassified as subgenotype IIB.<ref>{{Cite journal |last1=Lu |first1=Ling |last2=Ching |first2=Karen Z. |last3=de Paula |first3=Vanessa Salete |last4=Nakano |first4=Tatsunori |last5=Siegl |first5=Gunter |last6=Weitz |first6=Manfred |last7=Robertson |first7=Betty H. |date=2004-10-01 |title=Characterization of the complete genomic sequence of genotype II hepatitis A virus (CF53/Berne isolate) |url=https://www.microbiologyresearch.org/content/journal/jgv/10.1099/vir.0.80304-0 |journal=Journal of General Virology |language=en |volume=85 |issue=10 |pages=2943–2952 |doi=10.1099/vir.0.80304-0 |pmid=15448357 |issn=0022-1317 |access-date=2024-04-17 |archive-date=2024-04-17 |archive-url=https://web.archive.org/web/20240417123350/https://www.microbiologyresearch.org/content/journal/jgv/10.1099/vir.0.80304-0 |url-status=live }}</ref> Genotype III has been isolated from both humans and [[owl monkey]]s. Most human isolates are of genotype I.<ref name=dePaula2002>{{cite journal |vauthors=de Paula VS, Baptista ML, Lampe E, Niel C, Gaspar AM |title=Characterization of hepatitis A virus isolates from subgenotypes IA and IB in Rio de Janeiro, Brazil |journal=J. Med. Virol. |volume=66 |issue=1|pages=22–7 |date=January 2002 |pmid=11748654 |doi=10.1002/jmv.2106|s2cid=42775132 }}</ref> Of genotype I isolates, subtype IA accounts for the majority.
-The mutation rate in the genome has been estimated to be {{nobr|1.73–9.76 × 10<sup>−4</sup>}} nucleotide substitutions per site per year.<ref name=Moratorio2007>{{cite journal |vauthors=Moratorio G, Costa-Mattioli M, Piovani R, Romero H, Musto H, Cristina J |title=Bayesian coalescent inference of hepatitis A virus populations: evolutionary rates and patterns |journal=J. Gen. Virol.|volume=88 |issue=Pt 11 |pages=3039–42 |date=November 2007 |pmid=17947528 |doi=10.1099/vir.0.83038-0|doi-access=free }}</ref><ref name=Kulkarni2009>{{cite journal |vauthors=Kulkarni MA, Walimbe AM, Cherian S, Arankalle VA |title=Full length genomes of genotype IIIA Hepatitis A Virus strains (1995–2008) from India and estimates of the evolutionary rates and ages |journal=Infect. Genet. Evol. |volume=9 |issue=6 |pages=1287–94 |date=December 2009 |pmid=19723592 |doi=10.1016/j.meegid.2009.08.009}}</ref> The human strains appear to have diverged from the simian about 3600 years ago.<ref name=Kulkarni2009/> The mean age of genotypes III and IIIA strains has been estimated to be 592 and 202 years, respectively.<ref name=Kulkarni2009/>
+The mutation rate in the genome has been estimated to be {{nobr|1.73–9.76 × 10<sup>−4</sup>}} nucleotide substitutions per site per year.<ref name=Moratorio2007>{{cite journal |vauthors=Moratorio G, Costa-Mattioli M, Piovani R, Romero H, Musto H, Cristina J |title=Bayesian coalescent inference of hepatitis A virus populations: evolutionary rates and patterns |journal=J. Gen. Virol.|volume=88 |issue=Pt 11 |pages=3039–42 |date=November 2007 |pmid=17947528 |doi=10.1099/vir.0.83038-0|doi-access=free }}</ref><ref name=Kulkarni2009>{{cite journal |vauthors=Kulkarni MA, Walimbe AM, Cherian S, Arankalle VA |title=Full length genomes of genotype IIIA Hepatitis A Virus strains (1995–2008) from India and estimates of the evolutionary rates and ages |journal=Infect. Genet. Evol. |volume=9 |issue=6 |pages=1287–94 |date=December 2009 |pmid=19723592 |doi=10.1016/j.meegid.2009.08.009|bibcode=2009InfGE...9.1287K }}</ref> The human strains appear to have diverged from the simian about 3600 years ago.<ref name=Kulkarni2009/> The mean age of genotypes III and IIIA strains has been estimated to be 592 and 202 years, respectively.<ref name=Kulkarni2009/>
 ===Structure===
@@ Line 110: / Line 111: @@
 ===Transmission===
-The virus spreads by the [[fecal–oral route]], and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A can be transmitted by the [[parenteral]] route, but very rarely by blood and blood products. Food-borne outbreaks are common,<ref name="pmid16848078">{{cite journal| vauthors=Brundage SC, Fitzpatrick AN| title=Hepatitis A| journal=Am Fam Physician| volume=73| issue=12| pages=2162–8| year=2006| pmid=16848078| url=http://www.aafp.org/afp/2006/0615/p2162.html| url-status=live| archive-url=https://web.archive.org/web/20140309112259/http://www.aafp.org/afp/2006/0615/p2162.html| archive-date=2014-03-09}}</ref> and ingestion of [[shellfish]] cultivated in polluted water is associated with a high risk of infection.<ref name="pmid10946842">{{cite journal| author=Lees D| title=Viruses and bivalve shellfish| journal=Int. J. Food Microbiol.| volume=59| issue=1–2| pages=81–116| year=2000| pmid=10946842| doi=10.1016/S0168-1605(00)00248-8}}</ref>
+The virus primarily spreads by the [[fecal–oral route]],<ref name="pmid17151052">{{cite journal |last1=Gilson |first1=R |last2=Brook |first2=MG |date=December 2006 |title=Part 2: Testing guidelines for individual sexually transmitted infections — Hepatitis A, B, and C |journal=[[Sexually Transmitted Infections (journal)|Sexually Transmitted Infections]] |publisher=[[BMJ Group]] |volume=82 |issue=4 |pages=35-39 |doi=10.1136/sti.2006.023218 |issn=1472-3263 |pmc=2563900 |pmid=17151052 |quote=Hepatitis A virus (HAV) is transmitted faeco-orally. There is evidence for sexual transmission between homosexual men with several outbreaks reported. The specific risk factors are not well defined but probably relate to oro-anal or digital-rectal contact, particularly in settings such as public saunas and dark rooms. Acute icteric hepatitis appears after an incubation period of 15–45 days, symptoms last for about 6 weeks, and it is only rarely fatal. Most infections are asymptomatic (but severity increases with age). Infectivity lasts from approximately 2 weeks before the onset of jaundice to 1 week after.}}</ref> and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A can be transmitted by the [[parenteral route]], but very rarely by blood and blood products. Food-borne outbreaks are common,<ref name="pmid16848078">{{cite journal| vauthors=Brundage SC, Fitzpatrick AN| title=Hepatitis A| journal=Am Fam Physician| volume=73| issue=12| pages=2162–8| year=2006| pmid=16848078| url=http://www.aafp.org/afp/2006/0615/p2162.html| url-status=live| archive-url=https://web.archive.org/web/20140309112259/http://www.aafp.org/afp/2006/0615/p2162.html| archive-date=2014-03-09}}</ref> and ingestion of [[shellfish]] cultivated in [[Water pollution|polluted water]] is associated with a high risk of infection.<ref name="pmid10946842">{{cite journal| author=Lees D| title=Viruses and bivalve shellfish| journal=Int. J. Food Microbiol.| volume=59| issue=1–2| pages=81–116| year=2000| pmid=10946842| doi=10.1016/S0168-1605(00)00248-8}}</ref> HAV can also be spread through [[Sexually transmitted infection|sexual contact]], specifically [[Anilingus|oro–anal]] and [[Anal fingering|digital–rectal]] sexual acts.<ref name="pmid17151052"/> [[Humans]] are the only natural reservoir and [[disease vector]] of the HAV virus; no known insect or other animal vectors can transmit the virus. A chronic HAV state has not been reported.<ref>"Hepatitis A." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2015. Web. 25 Oct. 2016.</ref>
-About 40% of all acute viral hepatitis is caused by HAV.<ref name="Murray, P. r. 2005"/>  Infected individuals are infectious prior to onset of symptoms, roughly 10 days following infection.  The virus is resistant to [[detergent]], acid (pH 1), solvents (e.g., [[diethyl ether|ether]], [[chloroform]]), drying, and temperatures up to 60&nbsp;°C.  It can survive for months in fresh and salt water.  Common-source (e.g., water, restaurant) outbreaks are typical.  Infection is common in children in developing countries, reaching 100% incidence, but following infection, lifelong [[immunity (medical)|immunity]] results.  HAV can be inactivated by [[chlorine]] treatment (drinking water), [[formalin]] (0.35%, 37&nbsp;°C, 72 hours), [[peracetic acid]] (2%, 4 hours), beta-propiolactone (0.25%, 1 hour), and [[UV radiation]] (2 μW/cm<sup>2</sup>/min). HAV can also be spread through [[Sexually transmitted infection|sexual contact]] specifically [[anilingus|oroanal sexual acts]].{{citation needed|date=June 2021}}
+About 40% of all acute [[viral hepatitis]] is caused by HAV.<ref name="Murray, P. r. 2005"/> Infected individuals are infectious prior to onset of symptoms, roughly 10 days following infection. The virus is resistant to [[detergent]], acid (pH 1), solvents (e.g., [[Diethyl ether|ether]], [[chloroform]]), drying, and temperatures up to 60&nbsp;°C.  It can survive for months in fresh and salt water. Common-source (e.g., water, food) outbreaks are typical. Infection is common in children in [[Developing country|developing countries]], reaching 100% incidence, but following infection, lifelong [[immunity (medical)|immunity]] results.  HAV can be inactivated by [[chlorine]] treatment (drinking water), [[formalin]] (0.35%, 37&nbsp;°C, 72 hours), [[peracetic acid]] (2%, 4 hours), beta-propiolactone (0.25%, 1 hour), and [[UV radiation]] (2 μW/cm<sup>2</sup>/min).
-In [[developing country|developing countries]], and in regions with poor hygiene standards, the rates of infection with this virus are high<ref name="pmid16271541">{{cite journal|author = Steffen R| title = Changing travel-related global epidemiology of hepatitis A|journal = Am. J. Med.| volume = 118 |issue=Suppl 10A| pages = 46S–49S|date=October 2005|pmid = 16271541| doi = 10.1016/j.amjmed.2005.07.016}}</ref> and the illness is usually contracted in early childhood. As incomes rise and access to clean water increases, the incidence of HAV decreases.<ref name="pmid15831565">{{cite journal|doi=10.1093/ije/dyi062|vauthors=Jacobsen KH, Koopman JS | title=The effects of socioeconomic development on worldwide hepatitis A virus seroprevalence patterns| journal=Int J Epidemiol| volume=34| issue=3| pages=600–9| year=2005| pmid=15831565| doi-access=free}}</ref> In developed countries, though, the infection is contracted primarily by susceptible young adults, most of whom are infected with the virus during trips to countries with a high incidence of the disease<ref name="pmid16271543"/> or through contact with infectious persons.
+In [[Developing country|developing countries]], and in regions with poor hygiene standards, the rates of infection with this virus are high<ref name="pmid16271541">{{cite journal|author = Steffen R| title = Changing travel-related global epidemiology of hepatitis A|journal = Am. J. Med.| volume = 118 |issue=Suppl 10A| pages = 46S–49S|date=October 2005|pmid = 16271541| doi = 10.1016/j.amjmed.2005.07.016}}</ref> and the illness is usually contracted in early childhood. As incomes rise and access to clean water increases, the incidence of HAV decreases.<ref name="pmid15831565">{{cite journal|doi=10.1093/ije/dyi062|vauthors=Jacobsen KH, Koopman JS | title=The effects of socioeconomic development on worldwide hepatitis A virus seroprevalence patterns| journal=Int J Epidemiol| volume=34| issue=3| pages=600–9| year=2005| pmid=15831565| doi-access=free}}</ref> In developed countries, though, the infection is contracted primarily by susceptible young adults, most of whom are infected with the virus during trips to countries with a high incidence of the disease<ref name="pmid16271543"/> or through contact with infectious persons.
-Humans are the only natural reservoir of the virus. No known insect or other animal vectors can transmit the virus. A chronic HAV state has not been reported.<ref>"Hepatitis A." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2015. Web. 25 Oct. 2016.</ref>
 ==Diagnosis==
@@ Line 136: / Line 136: @@
 The vaccine is given by injection.  An initial dose provides protection lasting one year starting 2–4 weeks after vaccination; the second booster dose, given six to 12 months later, provides protection for over 20 years.<ref name=CDC_2006 />
-The vaccine was introduced in 1992 and was initially recommended for persons at high risk. Since then, Bahrain and Israel have embarked on elimination programmes.<ref name="André2006">{{cite journal | author = André FE | year = 2006 | title = Universal mass vaccination against hepatitis A | journal = Curr Top Microbiol Immunol | volume = 304 | pages = 95–114 | pmid = 16989266| doi = 10.1007/3-540-36583-4_6 | series = Current Topics in Microbiology and Immunology | isbn = 978-3-540-29382-8 }}</ref> In countries where widespread vaccination has been practised, the incidence of hepatitis A  has decreased dramatically.<ref>{{cite journal |title=Changing epidemiology of hepatitis A and hepatitis E in urban and rural India (1982-98) |journal=Journal of Viral Hepatitis |date=21 December 2001 |volume=8 |issue=4 |pages=293–303 |doi=10.1046/j.1365-2893.2001.00279.x |pmid=11454182 |vauthors=Arankalle VA, Chadha MS, Chitambar SD, Walimbe AM, Chobe LP, Gandhe SS|s2cid=8761651 }}</ref><ref>{{cite journal |title=Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis |journal=Vaccine |date=22 June 2015 |volume=33 |issue=28 |pages=3200–3207 |doi=10.1016/j.vaccine.2015.04.100 |publisher=Elseiver |last1=Estripeaut |first1=Dora |last2=Contreras |first2=Rodolfo |last3=Tinajeros |first3=Olga |last4=Castrejón |first4=Maria Mercedes |last5=Shafi |first5=Fakrudeen |last6=Ortega-Barria |first6=Eduardo |last7=Deantonio |first7=Rodrigo |doi-access=free |pmid=25981490 }}</ref><ref name=Cui2009>{{cite journal |vauthors=Cui F, Hadler SC, Zheng H, Wang F, Zhenhua W, Yuansheng H, Gong X, Chen Y, Liang X | year = 2009 | title = Hepatitis A surveillance and vaccine use in China from 1990 through 2007 | journal = J Epidemiol | volume = 19 | issue = 4| pages = 189–195 | pmid = 19561383 | pmc = 3924108 | doi = 10.2188/jea.JE20080087|display-authors=etal}}</ref><ref name=Daniels2009>{{cite journal| vauthors = Daniels D, Grytdal S, Wasley A| title = Surveillance for acute viral hepatitis — United States, 2007| journal = MMWR Surveill Summ| volume = 58| issue = 3| pages = 1–27| date = May 2009| pmid = 19478727| url = https://www.cdc.gov/mmwr/pdf/ss/ss5803.pdf| url-status = live| archive-url = https://web.archive.org/web/20120519170105/http://www.cdc.gov/mmwr/PDF/ss/ss5803.pdf| archive-date = 2012-05-19}}</ref>
+The vaccine was introduced in 1992 and was initially recommended for persons at high risk. Since then, Bahrain and Israel have embarked on elimination programmes.<ref name="André2006">{{cite book |vauthors=André FE |chapter=Universal Mass Vaccination Against Hepatitis A |year=2006 |title=Mass Vaccination: Global Aspects — Progress and Obstacles |volume=304 |pages=95–114 |pmid=16989266| doi=10.1007/3-540-36583-4_6 |series=Current Topics in Microbiology and Immunology |isbn=978-3-540-29382-8}}</ref> In countries where widespread vaccination has been practised, the incidence of hepatitis A  has decreased dramatically.<ref>{{cite journal |title=Changing epidemiology of hepatitis A and hepatitis E in urban and rural India (1982-98) |journal=Journal of Viral Hepatitis |date=21 December 2001 |volume=8 |issue=4 |pages=293–303 |doi=10.1046/j.1365-2893.2001.00279.x |pmid=11454182 |vauthors=Arankalle VA, Chadha MS, Chitambar SD, Walimbe AM, Chobe LP, Gandhe SS |s2cid=8761651}}</ref><ref>{{cite journal |title=Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis |journal=Vaccine |date=22 June 2015 |volume=33 |issue=28 |pages=3200–3207 |doi=10.1016/j.vaccine.2015.04.100 |publisher=Elseiver |last1=Estripeaut |first1=Dora |last2=Contreras |first2=Rodolfo |last3=Tinajeros |first3=Olga |last4=Castrejón |first4=Maria Mercedes |last5=Shafi |first5=Fakrudeen |last6=Ortega-Barria |first6=Eduardo |last7=Deantonio |first7=Rodrigo |doi-access=free |pmid=25981490 }}</ref><ref name=Cui2009>{{cite journal |vauthors=Cui F, Hadler SC, Zheng H, Wang F, Zhenhua W, Yuansheng H, Gong X, Chen Y, Liang X | year = 2009 |title=Hepatitis A surveillance and vaccine use in China from 1990 through 2007 |journal=J Epidemiol |volume=19 |issue=4| pages=189–195 |pmid=19561383 |pmc=3924108 |doi=10.2188/jea.JE20080087 |display-authors=etal}}</ref><ref name=Daniels2009>{{cite journal| vauthors=Daniels D, Grytdal S, Wasley A| title = Surveillance for acute viral hepatitis — United States, 2007| journal=MMWR Surveill Summ| volume=58| issue=3| pages=1–27| date=May 2009| pmid=19478727| url=https://www.cdc.gov/mmwr/pdf/ss/ss5803.pdf| url-status=live| archive-url=https://web.archive.org/web/20120519170105/http://www.cdc.gov/mmwr/PDF/ss/ss5803.pdf| archive-date=2012-05-19}}</ref>
-In the United States, vaccination of children is recommended at 1 and 2 years of age;<ref name=AFP2012/> hepatitis A vaccination is not recommended in those younger than 12 months of age.<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/hav/havfaq.htm|title=Hepatitis A Questions and Answers for Health Professionals {{!}} Division of Viral Hepatitis {{!}} CDC|date=2018-07-27|website=www.cdc.gov|language=en-us|access-date=2018-08-15}}</ref> It is also recommended in those who have not been previously immunized and who have been exposed or are likely to be exposed due to travel.<ref name=AFP2012/> The CDC recommends vaccination against infection for [[men who have sex with men]].<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/populations/msm.htm|title=Men Who Have Sex with Men {{!}} Populations and Settings {{!}} Division of Viral Hepatitis {{!}} CDC|date=31 May 2015|website=www.cdc.gov|language=en-us|access-date=2017-12-13}}</ref>
+In the United States, vaccination of children is recommended at 1 and 2 years of age;<ref name=AFP2012/> hepatitis A vaccination is not recommended in those younger than 12 months of age.<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/hav/havfaq.htm|title=Hepatitis A Questions and Answers for Health Professionals {{!}} Division of Viral Hepatitis {{!}} CDC|date=2018-07-27|website=www.cdc.gov|language=en-us|access-date=2018-08-15|archive-date=2016-03-06|archive-url=https://web.archive.org/web/20160306221037/http://www.cdc.gov/hepatitis/hav/havfaq.htm|url-status=live}}</ref> It is also recommended in those who have not been previously immunized and who have been exposed or are likely to be exposed due to travel.<ref name=AFP2012/> The CDC recommends vaccination against infection for [[men who have sex with men]].<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/populations/msm.htm|title=Men Who Have Sex with Men {{!}} Populations and Settings {{!}} Division of Viral Hepatitis {{!}} CDC|date=31 May 2015|website=www.cdc.gov|language=en-us|access-date=2017-12-13|archive-date=2008-07-26|archive-url=https://web.archive.org/web/20080726165140/https://www.cdc.gov/hepatitis/populations/msm.htm|url-status=live}}</ref>
 ==Treatment==
@@ Line 145: / Line 145: @@
 ==Prognosis==
 In the United States in 1991, the [[mortality rate]] for  hepatitis A was estimated to be 0.015% for the general population, but ranged up to 1.8–2.1% for those aged 50 and over who were hospitalized with icteric hepatitis.<ref>{{Cite web|url=https://www.aabb.org/tm/eid/Documents/hepatitis-a-virus.pdf|title=AABB|access-date=2017-09-22|archive-date=2020-10-30|archive-url=https://web.archive.org/web/20201030200125/https://www.aabb.org/tm/eid/Documents/hepatitis-a-virus.pdf}}</ref> The risk of death from acute liver failure following HAV infection increases with age and when the person has underlying chronic liver disease.{{citation needed|date=June 2021}}
+Liver illness can be brought on by the hepatitis C virus, also known as Hep C or HCV. While the majority of kids and teenagers recover from the initial stage of HCV infection, 60–80% of them could show symptoms of a persistent liver infection. This may result in fatalities as well as far more severe liver issues. In the US, the hepatitis C virus is responsible for over 10,000 fatalities annually.
 Young children who are infected with hepatitis A typically have a milder form of the disease, usually lasting 1–3 weeks, whereas adults tend to experience a much more severe form of the disease.<ref name="pmid16848078" />
 ==Epidemiology==
-[[File:HAV prevalence 2005.svg|thumb|Hepatitis A distribution 2005 {{legend|#990000|High: prevalence higher than 8%}} {{legend|#FF9966|Intermediate: between 2% and 7%}} {{legend|#999999|Low : less than 2%}}]]
+[[File:HAV prevalence 2005.svg|thumb|upright=1.35|Hepatitis A distribution 2005 {{legend|#990000|High: prevalence higher than 8%}} {{legend|#FF9966|Intermediate: between 2% and 7%}} {{legend|#999999|Low : less than 2%}}]]
 Globally, symptomatic HAV infections are believed to occur in around 1.4 million people a year.<ref name=AFP2012/> About 114 million infections (asymptomatic and symptomatic) occurred all together in 2015.<ref name=GBD2015Pre/> Acute hepatitis A resulted in 11,200 deaths in 2015.<ref name=GBD2015De/> Developed countries have low circulating levels of hepatovirus A, while developing countries have higher levels of circulation.<ref name=Jacob2010>{{cite journal |last=Jacobsen|first=KH |author2=Wiersma, ST |title=Hepatitis A virus seroprevalence by age and world region, 1990 and 2005 |journal=Vaccine|date=24 September 2010 |volume=28 |issue=41 |pages=6653–7|pmid=20723630 |doi=10.1016/j.vaccine.2010.08.037}}</ref> Most adolescents and adults in developing countries have already had the disease, thus are immune.<ref name=Jacob2010/> Adults in midlevel countries may be at risk of disease with the potential of being exposed.<ref name=Jacob2010/>
@@ Line 155: / Line 156: @@
 Over 30,000 cases of hepatitis A were reported to the [[Centers for Disease Control and Prevention|CDC]] in the US in 1997, but the number has since dropped to less than 2,000 cases reported per year.<ref>{{cite web|url=https://www.cdc.gov/hepatitis/HAV/StatisticsHAV.htm|title=Hepatitis A Information for Health Professionals — Statistics and Surveillance|publisher=Centers for Disease Control and Prevention|access-date=28 January 2014|url-status=live|archive-url=https://web.archive.org/web/20140203000208/http://www.cdc.gov/hepatitis/HAV/StatisticsHAV.htm|archive-date=3 February 2014}}</ref>
-The most widespread hepatitis A outbreak in the United States occurred in 2018, in the state of Kentucky. The outbreak is believed to have started in November 2017.<ref name=KentuckyNews2019/> By July 2018 48% of the state's counties had reported at least one case of hepatitis A, and the total number of suspected cases was 969 with six deaths (482 cases in [[Louisville, Kentucky]]).<ref name=KentuckyNews2018>{{cite news|title=Officials: Kentucky's hepatitis A outbreak now worst in US|url=http://www.wkyt.com/content/news/Officials-Kentuckys-hepatitis-A-outbreak-now-worst-in-US-486818101.html|website=WKYT|publisher=Associated Press|date=June 28, 2018}}</ref> By July 2019 the outbreak had reached 5,000 cases and 60 deaths, but had slowed to just a few new cases per month.<ref name=KentuckyNews2019>{{cite news|title=Hepatitis A numbers down in Kentucky; health officials still urge vaccination|last=Wymer|first=Garrett|url=https://www.wkyt.com/content/news/Hepatitis-A-numbers-down-in-Kentucky-health-officials-still-urge-vaccination-566096281.html|publisher=WKYT|date=December 11, 2019}}</ref>
+The most widespread hepatitis A outbreak in the United States occurred in 2018, in the state of Kentucky. The outbreak is believed to have started in November 2017.<ref name=KentuckyNews2019/> By July 2018 48% of the state's counties had reported at least one case of hepatitis A, and the total number of suspected cases was 969 with six deaths (482 cases in [[Louisville, Kentucky]]).<ref name=KentuckyNews2018>{{cite news|title=Officials: Kentucky's hepatitis A outbreak now worst in US|url=http://www.wkyt.com/content/news/Officials-Kentuckys-hepatitis-A-outbreak-now-worst-in-US-486818101.html|website=WKYT|publisher=Associated Press|date=June 28, 2018|access-date=June 30, 2018|archive-date=August 9, 2020|archive-url=https://web.archive.org/web/20200809005835/https://www.wkyt.com/content/news/Officials-Kentuckys-hepatitis-A-outbreak-now-worst-in-US-486818101.html|url-status=live}}</ref> By July 2019 the outbreak had reached 5,000 cases and 60 deaths, but had slowed to just a few new cases per month.<ref name=KentuckyNews2019>{{cite news|title=Hepatitis A numbers down in Kentucky; health officials still urge vaccination|last=Wymer|first=Garrett|url=https://www.wkyt.com/content/news/Hepatitis-A-numbers-down-in-Kentucky-health-officials-still-urge-vaccination-566096281.html|publisher=WKYT|date=December 11, 2019|access-date=September 1, 2020|archive-date=October 27, 2020|archive-url=https://web.archive.org/web/20201027035323/https://www.wkyt.com/content/news/Hepatitis-A-numbers-down-in-Kentucky-health-officials-still-urge-vaccination-566096281.html|url-status=live}}</ref>
 Another widespread outbreak in the United States, the [[2003 United States hepatitis outbreak|2003 US hepatitis outbreak]], affected at least 640 people (killing four) in northeastern [[Ohio]] and southwestern [[Pennsylvania]] in late 2003. The outbreak was blamed on tainted [[scallion|green onion]]s [[Chi-Chi's|at a restaurant]] in [[Monaca, Pennsylvania]].<ref name="pmid14647018">{{cite journal| title = Hepatitis A outbreak associated with green onions at a restaurant—Monaca, Pennsylvania, 2003| journal = [[MMWR Morb. Mortal. Wkly. Rep.]]| volume = 52| issue = 47| pages = 1155–7| date = November 2003| pmid = 14647018| url = https://www.cdc.gov/mmwr/PDF/wk/mm5247.pdf| author1 = Centers for Disease Control and Prevention (CDC)| url-status = live| archive-url = https://web.archive.org/web/20111018051208/http://cdc.gov/mmwr/PDF/wk/mm5247.pdf| archive-date = 2011-10-18}}</ref><ref name="pmid16135833">{{cite journal |vauthors=Wheeler C, Vogt TM, Armstrong GL, etal | title = An outbreak of hepatitis A associated with green onions| journal = [[N. Engl. J. Med.]]| volume = 353| issue = 9| pages = 890–7|date=September 2005| pmid = 16135833| doi = 10.1056/NEJMoa050855| doi-access = free}}</ref> In 1988, more than 300,000 people in [[Shanghai]], China, were infected with HAV after eating [[clam]]s (''[[Anadara subcrenata]]'') from a contaminated river.<ref name="Murray, P. r. 2005"/>
-In June 2013, frozen berries sold by US retailer [[Costco]] and purchased by around 240,000 people were the subject of a recall, after at least 158 people were infected with HAV, 69 of whom were hospitalized.<ref>{{cite news |first=Elizabeth |last=Weise |title=118 sickened in hepatitis A outbreak linked to berries |newspaper=USA Today |date=18 June 2013 |url=https://www.usatoday.com/story/news/nation/2013/06/18/hepatitis-a-frozen-berries-118-sick/2434267/ |url-status=live |archive-url=https://web.archive.org/web/20170102092844/http://www.usatoday.com/story/news/nation/2013/06/18/hepatitis-a-frozen-berries-118-sick/2434267/ |archive-date=2 January 2017 }}</ref><ref>{{cite web |title=Outbreak Cases |date=28 October 2013 |work=Viral Hepatitis |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html |url-status=live |archive-url=https://web.archive.org/web/20130812072936/http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html |archive-date=12 August 2013 }}</ref> In April 2016, frozen berries sold by Costco were once again the subject of a recall, after at least 13 people in Canada were infected with HAV, three of whom were hospitalized.<ref>{{cite news |title=Recalled Costco frozen berries linked to 13 cases of Hepatitis A |newspaper=The Canadian Press |date=19 April 2016 |url=https://www.thestar.com/news/canada/2016/04/19/recalled-costco-frozen-berries-linked-to-13-cases-of-hepatitis-a.html/ |url-status=live |archive-url=https://web.archive.org/web/20170317050427/https://www.thestar.com/news/canada/2016/04/19/recalled-costco-frozen-berries-linked-to-13-cases-of-hepatitis-a.html |archive-date=17 March 2017 }}</ref> In Australia in February 2015, a recall of frozen berries was issued after at least 19 people contracted the illness following their consumption of the product.<ref>{{cite web |title=Frozen berries Heptitus A scare |date=17 February 2015 |newspaper=ABC News Australia |url=http://www.abc.net.au/news/2015-02-17/fourth-frozen-berry-product-recalled-in-hepatitis-a-scare/6126272 |url-status=live |archive-url=https://web.archive.org/web/20150219010441/http://www.abc.net.au/news/2015-02-17/fourth-frozen-berry-product-recalled-in-hepatitis-a-scare/6126272 |archive-date=19 February 2015 }}</ref> In 2017, California (particularly around San Diego), Michigan, and Utah reported outbreaks of hepatitis A that have led to over 800 hospitalizations and 40 deaths.<ref>{{cite web|url=http://www.sltrib.com/news/health/2017/11/19/utahs-hepatitis-a-outbreak-among-the-homeless-is-one-of-three-big-flare-ups-around-the-country/|title=Utah's hepatitis A outbreak among the homeless is one of three big flare-ups around the country|publisher=The Salt Lake Tribune|author=Ramseth, Luke|access-date=November 21, 2017|date=November 19, 2017}}</ref><ref>{{Cite web|url=http://wordrange.us/san-diego-is-struggling-with-a-huge-hepatitis-a-outbreak-is-it-coming-to-l-a/|title=San Diego is struggling with a huge hepatitis A {{!}} Word Range|website=wordrange.us|language=en-US|access-date=2017-09-25|archive-url=https://web.archive.org/web/20170925132309/http://wordrange.us/san-diego-is-struggling-with-a-huge-hepatitis-a-outbreak-is-it-coming-to-l-a/|archive-date=2017-09-25}}</ref><ref>{{cite news|last1=Smith|first1=Joshua Emerson|title=Grim conditions in public restrooms hurt fight to halt deadly hepatitis outbreak in San Diego|url=http://www.latimes.com/local/lanow/la-me-san-diego-hepatitis-restrooms-20170924-story.html|access-date=25 September 2017|agency=LA Times}}</ref>
+In June 2013, frozen berries sold by US retailer [[Costco]] and purchased by around 240,000 people were the subject of a recall, after at least 158 people were infected with HAV, 69 of whom were hospitalized.<ref>{{cite news |first=Elizabeth |last=Weise |title=118 sickened in hepatitis A outbreak linked to berries |newspaper=USA Today |date=18 June 2013 |url=https://www.usatoday.com/story/news/nation/2013/06/18/hepatitis-a-frozen-berries-118-sick/2434267/ |url-status=live |archive-url=https://web.archive.org/web/20170102092844/http://www.usatoday.com/story/news/nation/2013/06/18/hepatitis-a-frozen-berries-118-sick/2434267/ |archive-date=2 January 2017 }}</ref><ref>{{cite web |title=Outbreak Cases |date=28 October 2013 |work=Viral Hepatitis |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html |url-status=live |archive-url=https://web.archive.org/web/20130812072936/http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html |archive-date=12 August 2013 }}</ref> In April 2016, frozen berries sold by Costco were once again the subject of a recall, after at least 13 people in Canada were infected with HAV, three of whom were hospitalized.<ref>{{cite news |title=Recalled Costco frozen berries linked to 13 cases of Hepatitis A |newspaper=The Canadian Press |date=19 April 2016 |url=https://www.thestar.com/news/canada/2016/04/19/recalled-costco-frozen-berries-linked-to-13-cases-of-hepatitis-a.html/ |url-status=live |archive-url=https://web.archive.org/web/20170317050427/https://www.thestar.com/news/canada/2016/04/19/recalled-costco-frozen-berries-linked-to-13-cases-of-hepatitis-a.html |archive-date=17 March 2017 }}</ref> In Australia in February 2015, a recall of frozen berries was issued after at least 19 people contracted the illness following their consumption of the product.<ref>{{cite web |title=Frozen berries Heptitus A scare |date=17 February 2015 |newspaper=ABC News Australia |url=http://www.abc.net.au/news/2015-02-17/fourth-frozen-berry-product-recalled-in-hepatitis-a-scare/6126272 |url-status=live |archive-url=https://web.archive.org/web/20150219010441/http://www.abc.net.au/news/2015-02-17/fourth-frozen-berry-product-recalled-in-hepatitis-a-scare/6126272 |archive-date=19 February 2015 }}</ref> In 2017, California (particularly around San Diego), Michigan, and Utah reported outbreaks of hepatitis A that have led to over 800 hospitalizations and 40 deaths.<ref>{{cite web|url=http://www.sltrib.com/news/health/2017/11/19/utahs-hepatitis-a-outbreak-among-the-homeless-is-one-of-three-big-flare-ups-around-the-country/|title=Utah's hepatitis A outbreak among the homeless is one of three big flare-ups around the country|publisher=The Salt Lake Tribune|author=Ramseth, Luke|access-date=November 21, 2017|date=November 19, 2017|archive-date=November 21, 2017|archive-url=https://web.archive.org/web/20171121010034/http://www.sltrib.com/news/health/2017/11/19/utahs-hepatitis-a-outbreak-among-the-homeless-is-one-of-three-big-flare-ups-around-the-country/|url-status=live}}</ref><ref>{{Cite web|url=http://wordrange.us/san-diego-is-struggling-with-a-huge-hepatitis-a-outbreak-is-it-coming-to-l-a/|title=San Diego is struggling with a huge hepatitis A {{!}} Word Range|website=wordrange.us|language=en-US|access-date=2017-09-25|archive-url=https://web.archive.org/web/20170925132309/http://wordrange.us/san-diego-is-struggling-with-a-huge-hepatitis-a-outbreak-is-it-coming-to-l-a/|archive-date=2017-09-25}}</ref><ref>{{cite news|last1=Smith|first1=Joshua Emerson|title=Grim conditions in public restrooms hurt fight to halt deadly hepatitis outbreak in San Diego|url=http://www.latimes.com/local/lanow/la-me-san-diego-hepatitis-restrooms-20170924-story.html|access-date=25 September 2017|agency=LA Times|archive-date=25 September 2017|archive-url=https://web.archive.org/web/20170925180715/http://www.latimes.com/local/lanow/la-me-san-diego-hepatitis-restrooms-20170924-story.html|url-status=live}}</ref>
 ==See also==
@@ Line 181: / Line 182: @@
 {{Refbegin|}}
 * {{Curlie|Health/Conditions_and_Diseases/Digestive_System_Disorders/Liver/Hepatitis/Hepatitis_A/|Hepatitis A}}
-* [https://www.cdc.gov/ncidod/diseases/hepatitis/a/index.htm CDC's hepatitis A links]
+* [https://www.cdc.gov/ncidod/diseases/hepatitis/a/index.htm CDC's hepatitis A links] {{Webarchive|url=https://web.archive.org/web/20080605014956/http://www.cdc.gov/ncidod/diseases/Hepatitis/a/index.htm |date=2008-06-05 }}
-* [http://www.viprbrc.org/brc/home.do?decorator=picorna Virus Pathogen Database and Analysis Resource (ViPR): Picornaviridae]
+* [http://www.viprbrc.org/brc/home.do?decorator=picorna Virus Pathogen Database and Analysis Resource (ViPR): Picornaviridae] {{Webarchive|url=https://web.archive.org/web/20221031222834/https://www.bv-brc.org/ |date=2022-10-31 }}
-* [https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=208726 Human hepatitis A virus ]
+* [https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=208726 Human hepatitis A virus ] {{Webarchive|url=https://web.archive.org/web/20210428202003/https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=208726 |date=2021-04-28 }}
 {{Refend}}

Classification	D ICD-10: B15 ICD-10-CM: B15.9 ICD-9-CM: 070.0, 070.1 MeSH: D006506 DiseasesDB: 5757 SNOMED CT: 40468003
External resources	MedlinePlus: 000278 eMedicine: med/991 ped/977 Patient UK: Hepatitis A

v t e Consumer food safety
Adulterants, food contaminants	3-MCPD Aldicarb Antibiotic use in livestock Cyanide Formaldehyde HGH controversies Lead poisoning Melamine Mercury in fish Sudan I
Food additives	Flavorings Monosodium glutamate (MSG) Salt Sugar High-fructose corn syrup Vegetable oil controversy
Intestinal parasites, parasitic disease	Amoebiasis Anisakiasis Cryptosporidiosis Cyclosporiasis Diphyllobothriasis Enterobiasis Fasciolopsiasis Fasciolosis Giardiasis Gnathostomiasis Paragonimiasis Toxocariasis Toxoplasmosis Trichinosis Trichuriasis
Microorganisms	Botulism Campylobacter jejuni Clostridium perfringens Cronobacter Enterovirus Escherichia coli O104:H4 Escherichia coli O157:H7 Hepatitis A Hepatitis E Listeria Norovirus Rotavirus Salmonella Shigatoxigenic and verotoxigenic E. coli Vibrio cholerae
Pesticides	Chlorpyrifos DDT Lindane Malathion Methamidophos
Preservatives	Benzoic acid Ethylenediaminetetraacetic acid (EDTA) Sodium benzoate
Sugar substitutes	Acesulfame potassium Aspartame controversy Saccharin Sodium cyclamate Sorbitol Sucralose
Toxins, poisons, environment pollution	Aflatoxin Arsenic contamination of groundwater Benzene in soft drinks Bisphenol A Dieldrin Diethylstilbestrol Dioxin Mycotoxins Nonylphenol Shellfish poisoning
Food fraud	Bread Breast milk Egg Olive oil Prawn Seafood Shrimp Tea
Food processing	4-Hydroxynonenal Acid-hydrolyzed vegetable protein Acrylamide Food additives Food irradiation Heterocyclic amines Modified starch Nitrosamines Polycyclic aromatic hydrocarbon Shortening Trans fat Variant Creutzfeldt–Jakob disease Water fluoridation controversy
Food contamination incidents	Devon colic Swill milk scandal Esing Bakery incident 1858 Bradford sweets poisoning 1900 English beer poisoning Morinaga Milk arsenic poisoning incident Minamata disease Moroccan oil poisoning disaster 1959 [ar] 1971 Iraq poison grain disaster Toxic oil syndrome 1985 Austrian diethylene glycol wine scandal United Kingdom BSE outbreak Australian meat substitution scandal Jack in the Box E. coli outbreak 1996 Odwalla E. coli outbreak 2006 North American E. coli outbreaks ICA meat repackaging controversy 2008 Canada listeriosis outbreak 2008 Chinese milk scandal 2008 Irish pork crisis 2008 United States salmonellosis outbreak 2011 Germany E. coli outbreak 2011 United States listeriosis outbreak Bihar school meal poisoning 2013 horse meat scandal 2015 Mozambique funeral beer poisoning 2017 Brazil Operation Weak Meat 2017–2018 South African listeriosis outbreak 2018 Australian strawberry contamination 2024 United Kingdom Shigatoxigenic E. coli outbreak Kobayashi red yeast rice scandal Food safety incidents in China Food safety incidents in Taiwan Foodborne illness outbreaks death toll United States
Regulation, standards, watchdogs	Acceptable daily intake E number Food labeling regulations Food libel laws Food safety in Australia International Food Safety Network ISO 22000 Nutrition facts label Organic certification Quality Assurance International United Kingdom food information regulations
Institutions	Centre for Food Safety (Hong Kong) European Food Safety Authority Food and Drug Administration Food Information and Control Agency (Spain) Food Standards Agency (United Kingdom) Institute for Food Safety and Health International Food Safety Network Ministry of Food and Drug Safety (South Korea) Spanish Agency for Food Safety and Nutrition
Related topics	Curing (food preservation) Food and drink prohibitions Food marketing Food politics Food preservation Food quality Genetically modified food Conspiracy theories
Food portal Drink portal Category Commons Cookbook WikiProject

Taxon identifiers
Hepatovirus A	Wikidata: Q24722353 Wikispecies: Hepatovirus A CoL: 3KW2L EoL: 46698503 GBIF: 10364278 NCBI: 12092
Hepatitis A virus	Wikidata: Q4112120 IRMNG: 11459942